IMAGE  EVALUATION 
TEST  TARGET  (MT-3) 


1.0 


I.I 


1.25 


■  50     ™'^= 


1^ 


IM 

2.0 

1.8 


1-4    IIIIII.6 


V] 


<? 


/2 


7 


1/  "> 


o 


/ 


/A 


Photographic 

Sciences 
Corporation 


23  WEST  MAIN  STREET 

WEBSTER,  N.Y.  14580 

(716)  872-4503 


&» 


^ 


CIHM/ICMH 
Microfiche 


CIHM/iCIVIH 
Collection  de 
microfiches. 


Canadian  Institute  for  Historical  Microreproductions  /  Institut  Canadian  de  microreproductions  historiques 


vV 


Technical  and  Bibliographic  Notes/Notes  tachniquas  at  bibliographiquas 


The  Institute  has  attempted  to  obtain  the  best 
original  copy  available  for  filming.  Features  of  thia 
copy  which  may  be  bibliographically  unique, 
which  may  alter  any  of  the  images  in  the 
reproduction,  or  which  may  significantly  change 
the  usual  method  of  filming,  are  checked  below. 


L'Institut  a  microfilm^  le  meilleur  exemplaire 
qu'il  lui  a  6ti  possible  de  9«  procurer.  Les  details 
de  cet  exemplaire  qui  sont  paut-dtre  uniques  du 
point  de  vue  bibliographique,  qui  peuvent  modifier 
une  image  reproduite,  ou  qui  peuvent  exiger  une 
modification  dans  la  m^thode  normale  de  filmage 
sont  indiquAs  ci-dessous. 


0    Coloured  covers/ 
Couverture  de  couleur 


D 
D 


Covers  damaged/ 
Couverture  endommag^a 


Covers  restored  and/or  laminated/ 
Couverture  restaur^e  at/ou  pelliculAa 


D 
D 
D 


Coloured  pages/ 
Pagea  de  couleur 

Pages  damaged/ 
Pages  endommagias 

Pages  restored  and/or  laminated/ 
Pages  restauries  et/ou  pellicul^es 


□    Cover  title  missing/ 
Le  titre  de  couverture  manque 

I      I    Coloured  maps/ 


□ 


D 


D 


Cartes  giographiques  en  couleur 


Coloured  ink  (i.e.  other  than  blue  or  black)/ 
Encre  de  couleur  (t.b.  autre  que  bleu?  ou  noire) 


□    Coloured  plates  and/or  illustrations/ 
Planches  et/ou  illustrations  en  couleur 


I    .  .    Bound  with  other  material/ 
'^  I    ReM  avec  d'autres  documents 


Tight  binding  may  cause  shadows  or  distortion 
along  interior  margin/ 

La  re  liure  serr^e  peut  causer  de  I'ombra  ou  de  la 
distorsion  le  long  de  la  marge  int^rieure 

Blank  leaves  added  during  restoration  may 
appear  within  the  text.  Whenever  possible,  these 
have  been  omitted  from  filming/ 
II  se  peut  que  certaines  pages  blanches  ajoutdes 
lors  d'une  restauration  apparaissent  dans  le  texte, 
mais,  lorsque  cela  4tait  possible,  ces  pages  n'ont 
pas  6ti  filmies. 


D 
0 
D 
D 
D 
D 


Pages  discoloured,  stained  or  foxed/ 
Pages  ddcolories,  tachetdes  ou  piqudes 

Pages  detached/ 
Pages  ddtachies 

Showthrough/ 
Transparence 

Quality  of  print  varies/ 
Qualiti  inigale  de  I'impression 

Includes  supplementary  material/ 
Comprend  du  materiel  suppl^mentaire 

Only  edition  available/ 
Seule  Edition  disponible 

Pages  wholly  or  partially  obscured  by  errata 
slips,  tissues,  etc.,  have  been  refilmed  to 
ensure  the  best  possible  image/ 
Les  pages  totalement  ou  partieilement 
obscurcies  par  un  feuillet  d'errata.  une  pelure, 
etc.,  ont  M  filmdes  d  nouveau  de  facon  d 
obtenir  la  meilleure  image  possible. 


D 


Additional  comments:/ 
Commentaires  suppldmentaires; 


This  item  is  filmed  at  the  reduction  ratio  checked  below/ 

Ce  document  est  filmd  au  taux  de  reduction  indiqu^  ci-dessous. 


10X 

14X 

18X 

22X 

26X 

3GX 

J 

12X 


16X 


20X 


24X 


28X 


32X 


Th«  copy  film«d  h«r«  hat  b««n  r«pk'oduc«d  thanks 
to  tha  janarosity  of: 

Medical  Library 
McGilf  University 
Montreal 

Tha  Imagas  appaaring  hara  ara  tha  baat  quality 
posaibia  considaring  tha  condition  and  lagibility 
of  tha  original  copy  and  in  icaaping  with  tha 
filming  contract  spacifications. 


L'axamplaira  fiimA  fut  raproduit  grica  h  la 
gtnirosit*  da: 

Medical  Library 
McGill  University 
Montreal 

Laa  imagaa  suivantaa  ont  M  raproduitaa  avac  la 
plua  grand  soin,  compta  tanu  da  la  condition  at 
da  la  nattat*  da  l'axamplaira  film«.  at  ^n 
conformity  avac  las  conditions  du  contrat  da 
filmaga. 


Odginal  copias  in  printad  papar  covars  ara  filmad 
baginning  with  tha  front  covar  and  anding  on 
tha  last  paga  with  a  printad  or  illustratad  impraa* 
sion,  or  tha  bacic  covar  whan  appropriata.  All 
othar  original  copias  ara  filmad  baginning  on  tha 
first  paga  with  a  printad  or  illustratad  impraa- 
sion,  and  anding  on  tha  laat  paga  with  a  printad 
or  illustratad  imprassion. 


Tha  last  racordad  frama  on  aach  microficha 
shall  contain  tha  symbol  —^^  (moaning  "CON- 
TINUED"), or  tha  symbol  y  (moaning  "END"), 
whichavar  appliaa. 


Laa  axamplairaa  originaux  dont  la  couvartura  an 
papiar  aat  imprimta  sont  filmAs  an  commandant 
par  la  pramiar  plat  at  an  tarminant  soit  par  la 
darniAra  paga  qui  comporta  una  amprainta 
d'imprassion  ou  d'illustration,  soit  par  la  second 
plat,  salon  la  eaa.  Tous  las  autraa  axamplairaa 
originaux  sont  filmte  an  commandant  par  la 
pramiira  paga  qui  comporta  una  amprainta 
d'impraaaion  ou  d'illustration  at  an  tarminant  par 
la  darniira  paga  qui  comporta  una  talla 
amprainta. 

Un  daa  symbolaa  suivants  apparaTtra  sur  la 
darnlAra  imaga  da  chaqua  microficha,  salon  la 
cas:  la  symbols  -^  signifia  "A  SUIVRE",  la 
symbols  V  signifia  "FIN". 


Maps,  plataa,  charts,  ate,  may  ba  filmad  at 
diffarant  reduction  ratios.  Thoaa  too  larga  to  ba 
antiraiy  included  in  ona  axpoaura  ara  filmad 
baginning  in  tha  uppar  laft  hand  cornar,  laft  to 
right  and  top  to  bottom,  as  many  frames  as 
required.  The  following  diagrams  illustrate  the 
method: 


Les  cartea,  planches,  tableaux,  etc.,  peuvent  Atre 
filmte  A  dee  taux  da  reduction  diff Arents. 
Lorsque  le  document  est  trop  grand  pour  Atre 
reproduit  en  un  seul  clichA.  il  est  filmA  A  partir 
da  Tangle  aupAriaur  gauche,  de  gauche  A  droite, 
et  de  haut  en  baa,  an  prenant  la  nombra 
d'imagea  nAcaaaaira.  Las  diagrammes  suivants 
illustrant  la  mAthode. 


1 

2 

3 

1 

2 

3 

4 

5 

6 

Uf 


hi 


;;i 


^it 


.  i'-^'i 


^  ^''4 


14 


Hi:::i:r;i:msi:iiiiiis^^^^ 


is  There  a  Rampoldi's  Sign? 


CASEY  A.  WOOD,  M.D. 


RBPRINTIID  PROM 
MEDICINE. 

QEO.  S.  DAVIS,  Publisher. 

Januaify,  1896. 


mm 


>       [HRPKINTBD  prom   MKIiICINK,   JANUARY,    1896.] 

IS  THERE  A  RAHPOLDrS  SIGN? 

BY  CASKY  A.  WOOD,  M.D. 

In  looking  up  the  literature  of  a  subject  in  which  I  happened 
to  be  interested,  I  ran  across  the  first  pnper  by  Rampoldi  *  in  which 
he  invited  the  attention  of  the  profession  to  the  proposition  that  a 
transitory  but  recurrent  (and  unequal)  dilatation  of  the  pupils  is  an 
early  and  almost  constant  sign  of  the  ordinary  form  of  pulmonary 
phthisis,  and  that  this  pupillary  anomaly  results  from  an  irritation 
transmitted  by  way  of  the  sympathetic  to  the  nerves  supplying  the 
iris. 

I  was  induced  by  the  article  in  question  to  make  some  observa- 
tions on  my  own  account,  but  as  these  were  neither  sufficiently 
numerous  nor  extensive  to  enable  me  to  arrive  at  any  rational 
conclusion,  I  said  nothing  about  them.  In  the  la.st  number  of  the 
Atmali,  however,  Rampoldi  has  again  referred  to  the  matter  in  a 
way  that  makes  one  feel  that  a  proper  investigation  of  the  subject  is 
worth  while.  If  it  be  true  that  unequally  dilated  pupils  are  to  be 
seen  in  the  very  early  stages  of  phthisis  pulmonalis,  how  important 
it  is  that  we  should  be  on  the  lookout  for  such  an  easily  recognized 
sign  ! 

In  the  articlet  last  referred  to,  Rampoldi  reviews  the  opinions 
of  several  writers  on  this  subject,  and  publishes  his  later  experiences. 
At  the  last  International  Medical  Congress,  Destree  read  a  paper  % 
in  which  he  claimed  that  in  97  per  cent,  of  ca,ses  of  tubercular  phthi- 
sis he  had  observed  an  unequal  dilatation  of  the  pupils  dependent 
upon  irritation  of  the  sympathetic  plexus  at  the  hilus  of  the  lung 
from  disease  in  the  bronchial  glands.  This  sign,  he  claims,  often 
precedes  the  invasion  of  the  lung  tissue,  and  is  an  unfailing  indica- 
tion of  tuberculosis  of  the  bronchial  glands.  Cardarelli  draws  atten- 
tion to  the  fact  that  the  tubercular  character  of  the  swelling  in  the 
peribronchial  glands  has  been  recognized  for  a  very  long  time,  and 
that  these  glands,  like  the  mesenteric,  may  retain  the  bacillus  tuber- 
culosis in  a  state  of  latency. 

Destree  has  elsewhere  and  later  affirmed  that  after  long-con- 
tinued and  daily  study  of  these  cases  he  was  able  to  state  positively 
that  the  pupillary  condition  is  the   result  of  swelling  of  the  peri- 

*  A  nnali  di  O/lalmologia,  anno  xiv,  f asc.  4. 

f'Ancora  Sulle  Variazioni  Pupillari  dipendenti  da  Malattie  Polmonari  di  Natura 
Tubercolare,"  Annali  di  Ottalmologia,  anno  xxiii,  fasc.  6. 

X  "  Un  Segno  Prenionitorio  della  Tubercolosis  Polmonare,"  Riforma  Medica,  anno  x. 

No.  79. 


a  AV  THERE  A  RAMPOLDPS  SIGN? 

bronchial  glands  which,  pressing  upon  the  filaments  of  the  sympa- 
thetic, brings  about  the  mydriasis  referred  to,  and  that  he  had 
confirmed  the  fact  of  pressure  upon  the  nerve  by  many  autopsies. 
Moreover,  recent  researches  have  proved  that  the  peribronchial 
glands  are  usually  infected  very  early  in  pulmonary  tuberculosis — 
are  probably  tlje  first  tissue  invaded — and  if  we  could  be  put  into 
possession  of  a  sign  that  would  indicate  that  invasion,  it  is  easily 
understood  how  important  it  would  be  from  the  standpoint  both  of 
diagnosis  and  treatment. 

Rampoldi  shows  that  he  was  the  first  (in  1885)  to  draw  atten- 
tion to  this  sign  of  pulmonary  disease.  Later,  in  1886,  le  published 
a  case  which  seemed  to  confirm  the  experience  of  Oelil  ' '  that  it  is 
possible  to  transmit  a  primary  excitaiion  of  the  vagus  to  the  pupil 
by  way  of  that  sympathetic  branch  that  runs  from  the  superior  cer- 
vical ganglion  to  the  vagus  itself. ' ' 

In  addition  to  this  sign,  the  author  believes  the  following  history 
furnishes  evidence  of  further  implication  of  the  ocular  nerve-supply 
by  tubercular  disease  of  the  lungs; 

R.  A ,  domestic,  aged  16,  appeared  to  be  in  good  health,  but 

had  suffered  for  three  years  with  a  slight  cough,  thought  to  be  bron- 
chitic.  She  visited  the  clinic  on  accoiuit  of  the  drooping  of  the  right 
upper  lid,  which  had  been  noticed  the  previous  fortnight.  A  careful 
examination  of  the  eyes  was  made,  and  it  was  found  tha  the  patient 
had  a  decided  ptosis  on  the  right  side,  accompanied  T:  a  marked 
contraction  of  the  corresponding  pupil,  which  was,  at  th.  jame  time, 
sluggish  to  light  and  accommodation.  In  other  words,  she  had  a 
ptosis  with  an  unequal  dilatation  of  the  two  pupils.  There  was  no 
trace  of  posterior  synechiae,  and  no  refractive  error.  Vision  was 
normal  both  for  distance  and  near. 

Chiefly  on  account  of  the  irregular  innervation  of  the  iris  and 
levator  palpebrae  superioris  —  not  otherwise  explained  —  Rampoldi 
suspected  pulmonary  disease  and  sent  the  patient  to  the  medical 
clinic.     She  was  found  to  have  tuberculosis  of  the  right  apex. 


'^;^m^.^mm^m^''rr^^^^^^S0m:.-i<mm^s;miS^Sms^s:i 


I  I 


>j  -r  ."^^w^ww  n 


-.Bsfciaatfiwte--' 


I 


t'Htt  MiSDrcAL  AaK, 


MBmcmsu 

Thlf'lt  t}i«  title  of « iHnr  9edio«t  monthly 

miglx|i:e  ttii^t  hat,fii«de  ftt  ai^earopee  npon 

^.^  .our  txcbtnge  tible,  Md  which  w^  mwt 

iS    *S^  *•**"**•    **f»thofe«uH(oftheer>. 

jP^JJ  i  ««?^  of  Jbr.  C(MH  8,  Dwft*  tbo  well  known 

S*t  ^teS*^'"*  W:Kojrer,ordW««>,Md 

JMJry^^  o'  *ft«  Wotthwi«.;,V-«/iS, 

W'*f  >i*pr«Mntativt.  of  no  Caftege, 

MAfiiliiog:  Iipiise»  or  mtaiifitetttrirty 

^^i^.  .,v'»T^"»  *W»t  ,li  ^monfly,  •high  el«it  ooimo- 

.  S5^'tf^^**®9»»  paWlcalloo..' ^ueh  tMbgg as 

wt^m^^'i'f^Si^'  ?.^3^<<M».  ^V,  S.  Ciirl»topber, 

M^  w»    ^^ie»«r|iai^ve  tbondiMt  MkQcaKce  of  cht^- 

AorSS®  ^^  *"^*^**.  "■*^'^'«  ^  '"Herpes  Zoster 
cfaio^;  S   St^J'^^y  "«•«?*'«'  ^  the  »dn^  in 

wpBHe*    fBffettt  Of  La  Grippe  on  the  Nose,  Throat. 

ivd  fiatv"  ..A  notable  innovation,  qne  we 

bearttlycotwniend,  is  the  absence  of  "editorf- 

«.t!E;,**.8inee  U  is  to  be  presumed  the  editor  w|tt 

r^bro  «xpr«$sloB  to  his  opinions  in  direct  Per. 

«owil  tKintrftmtionft  ■^'■ 

r  A  Journal  of  such  complete  independent 

iJd«^    Wd  W^h  literary  standing  as  J/rduiw  im 

^Jl^    tohffcewiieedcd.  *     -  -  *» 


7re.of  a 

•Ufllltd 


^moAL  WSTORy.  AWr. 


MEDICINE 

AJVtontltiy  Jounwl  of  McdkltMand  Surgtry. 
DABOID  If.  MOfia,  M.  0.» 


vtt 


JUNE.   1S9). 


«.<!V 


OOMTeiHTa. 

MMIMAL  ARTKUU,  ^^^ 

'tviMeOMipnuTiiMcsiicninwTtwuicikTiaMAiiattitMTiMDrimMMVk  *r.. 

gga^^^  I>UI^  A.Mt  M-U^. "•'•'  •'  '•••-» ■*•••.•• ..■■.;...«  Mt 

nsMaawAi'MwmawAi'nuT'nNTorciMuuniiiiM.  MiMa«.M<»M<.«.,M. 

MA. „„..„...,«. •... - A.  «...-...  —  IB 

MMTiMo'  MmAMHt-n  Tm  lu  ivoiw  mrtM.  (•  »>•«•«.  •■•><•.  ■  ■>. m 

TMItMMMtiWVr^flUW.  m   p.  •»««.  »>...«,.-........-„.-.-....». ju.y^ 


«»«•*■  WlMUNtlKiHn.    l|rA>uM:LMllM<M,HB,M«U«Mt<<t<M%llf.....«i 

NurM  •■  !■•»  IM« "•••" 


■ooK  rnvKwib 

HNMB^  or  JMOtCM.  MHMM. 
»*»  M— ■*  I 

MMMgi^^  wMmOmMN.*  ■.•••<•••••« ■•••    •  iil 

«ii.  wiini  n  titiutt  Ciwiii  lt«w* •    tttSmtimntnitMt—mit *..»....* 

irtnMMiw  u^«MiM  la  Vt^MCvM Mt  ^t^wtnwu^fwtTnfmrrr 

A N<» M.Jmi »>....« ,...^".','.'.'1Z'.'.'.  iM     T>» Wlrm«l ltrt»»i« »H««fc»l «iiil»i> * 

H*taM»MlPMI>l>taMtW«)Mta im     f.««rt'im.u»mll«l«fVl#Mlfl.l.m iM 

>»«.»»  rimiiiom » »»«i  trufcw. '■«  AaH.ie»i»;<«M»««it»Ww«»M«»» 

ftmlWM...,  ..>.. .........l ■«»        I«II»1.«1IH»«KII«1»IW»M« „.. .  * 

•ft.M-n.WH<MtonM.„ ......»««  «tort^B»~«ti«».. ...»...■_......".* 

..«.iM.««  Tin  fmhUMTWIlBMI  «  W Ill  n  »«» 

PATnOUMTii  •*»#»•• ■•-    ••* 

Ahm  YXIm  AMfkr  •<  il»  Lmr,  am  i>irf« 

ll«ltHMtHHMllC«UrU)<lCliaitMOfcMlf««.  i^ 

TKMAMIUnCI. 

ONilMlUX !»••»<«■•<»«>«•■«•  >*■«»  IWIKKJ  ■llUniJlll-  WINHTWmt...,—  IW 

tftUmitl^tlrVmmi...::. ,-..  «»     «W«I >■■•'"'■•"—< " •" 

1»«w<0M4iiirMni««M<Mii« nr  •HmuuMMsr. 

lima  uffnaiiVK' «•<... ■•  rmMt«<.jlM<KMiMaMl  KikmlnpiMH 

Timiu»»nlT»|M»ri;«*.. -....  -•      WiMl.|< m 

«.«■«  wmmiu  i»  m*  iii  m  <u»» m 

MNfiMlalktTmMMUrfOwllFHnwM*  _^.,.^j.. 

Mi „.,. «...^ .Ik  tiniiioiim «i rtwiiim..- 


M»  vnCMuniv. 


corvtwuT  4m. 
<M.  B.  BAVia.  PaMlukcr. 


CutarM  m%  0»  Poat-offlva  at  Datr«t1«  Mfl«i.,  p«  m««m«-«ibm  m«n«r. 


